BACKGROUND Overhanging filtering bleb is a common complication after trabeculectomy and surgical repair is an effective treatment when the patient presents with apparent symptoms.Filtering bleb relevant infection incl...BACKGROUND Overhanging filtering bleb is a common complication after trabeculectomy and surgical repair is an effective treatment when the patient presents with apparent symptoms.Filtering bleb relevant infection including in the filtering bleb itself and even endophthalmitis in some severe cases has been reported.However,corneal fungal infection after filtering bleb repair is rarely reported.CASE SUMMARY A 57-year-old Chinese man who had sensations of redness and foreign body sensations in the left eye 3 wk after repair of overhanging filtering bleb.3 wk ago,due to sensations of a foreign body in the left eye for 3 years with worsening for 3 mo.The patient was diagnosed as overhanging filtering bleb and underwent a repair of overhanging filtering bleb.Postoperative,the filtering bleb formed well and the intraocular pressure is normal.But the patient gradually develop redness,pain and a grey infiltrate of the cornea in the eye.Finally it developed into fungal corneal ulcer.Through asking the medical history,we found the patient had irregularly self-medicated for years with glucocorticoid eye drops for years to relieve the foreign body sensation in the eye caused by filtering bleb overhanging.Because the glucocorticoid eye drops he used years ago had provide normal sensation to the eye.After 3 mo of anti-fungal treatment,the inflammation was controlled.CONCLUSION In addition to avoiding the development of overhanging filtering bleb after trabeculectomy,the present case report also suggests that clinicians should pay more attention to the patient’s ocular self-medication history.Particularly in patients with a history of glaucoma or eye surgery.Because these patients may be exposed to more types of eye drops than other individuals,they may select the wrong medi-cations for long-term use,based on their previous experience.展开更多
BACKGROUND The major reason for filtering bleb failure or scarring of the bleb site is due to excessive scarring after glaucoma filtration surgery in the clinic.Traditional Chinese medicine has preeminence in the prev...BACKGROUND The major reason for filtering bleb failure or scarring of the bleb site is due to excessive scarring after glaucoma filtration surgery in the clinic.Traditional Chinese medicine has preeminence in the prevention of fibrosis formation through the regulation of systemic circulation and improvement of the properties of the inflammatory cells in the blood.AIM To examine the clinical efficacy of using the Modified Cortex Mori Capsules(MCMC;Chinese name:Jiawei Sangbaipi Capsules)in the success rate of functional filtering blebs after glaucoma filtering surgery in clinical patients.METHODS Sixty resurgery glaucoma patients were randomly divided into two groups:30 patients in surgery with the placebo group and 30 patients in surgery with the MCMC group.Patients took either the placebo or the MCMC 2 wk before and after surgery.Postoperative morphology and function filtering bleb,visual acuity,intraocular pressure,postoperative complications,the success rate of filtration surgery and clinical efficacy were observed.RESULTS Fifty patients completed the study.The percentage of functional filtering blebs in the surgery plus MCMC group was 84%at 6 mo after surgery,which was higher than surgery plus placebo group(64%,P<0.05).The surgical success rate in the MCMC and placebo groups were 79%±8.3%and 57%±10.6%respectively(P<0.05).The visual acuity,intraocular pressure and the postoperative complications in the two groups had no significant differences.CONCLUSION Glaucoma filtering surgery while taking MCMC not only reduced excessive scar formation and increased the success rate of functional filtering blebs but also improved the success of glaucoma filtration operations.展开更多
AIM： To study the role of ultrasound biomicroscopy（UBM） in the assessment of the bleb function after trabeculectomy with mitomycin C（MMC）. METHODS： This was a cross-sectional study including all cases had underg...AIM： To study the role of ultrasound biomicroscopy（UBM） in the assessment of the bleb function after trabeculectomy with mitomycin C（MMC）. METHODS： This was a cross-sectional study including all cases had undergone trabeculectomy with MMC 0.2 mg/mL for 3 min. Participants were recruited from the follow-up cases at Department of Ophthalmology, Tanta University in the period from August 2015 to August 2016. Full history taking and ophthalmological examination were performed. Intraocular pressure（IOP） was measured using Goldmann applanation tonometry and the history of prescribed postoperative antiglaucoma medications was recorded. Accordingly, the trabeculectomy blebs were divided clinically into successful blebs when the IOP post-operative was ≤18 mmHg without medications. Scanning examination of the filtering bleb using UBM examination was performed at the period from 2 to 36 mo after trabeculectomy（13.6±9.7 m o）. RESULTS： This study included 33 trabeculectomy filtering blebs of 25 patients（9 males and 16 females）. The mean age of patients was 53.2±14.2 y（range 25-71y）. We had 20 eyes with complete success, 9 eyes with qualified success, and 4 eyes with failure after trabeculectomy with MMC. The blebs were classified into successful blebs（IOP ≤18 mmHg without antiglaucoma medications）, others were classified into qualified successful and failed blebs. There was a significant correlation between certain UBM findings（intra-bleb reflectivity, draining sub-scleral tract, bleb height, and intrableb fluid cysts） and cases with different grades of clinical functional success（P〈0.01）.CONCLUSION： UBM is an objective tool in the functional assessment of the post-trabeculectomy filtering bleb through a significant correlation between certain UBM parameters and the different grades of clinical functional success.展开更多
AIM： To evaluate the effectiveness of autologous conjunctival flap surgery for repairing the late-onset filtering bleb leakage after trabeculectomy.METHODS： This study retrospectively reviewed 106 eyes from 106 pati...AIM： To evaluate the effectiveness of autologous conjunctival flap surgery for repairing the late-onset filtering bleb leakage after trabeculectomy.METHODS： This study retrospectively reviewed 106 eyes from 106 patients with late-onset filtering bleb leakage after trabeculectomy who received autologous conjunctival flap surgery at the Zhongshan Ophthalmic Centre from 2005 to 2015. The basic information was recorded, and the interval time between trabeculectomy and autologous conjunctival flap surgery as well as related risk factors, intraocular pressure（IOP）, anterior chamber depth（ACD） and best corrected visual acuity（BCVA） were analysed. Moreover, 41 patients who completed the 1-year follow up were analysed to determine the IOP and BCVA changes and long-term success rates.RESULTS： The 50 male and 56 female subjects（average age 39.13±17.96 y） included 47（44.34%） and 33（31.13%） cases of primary open angle and primary angle-closure glaucoma. The mean interval between trabeculectomy and repair surgery was 60.60±56.92（3-264）mo. The mean mitomycin（MMC） concentration during trabeculectomy was 0.27±0.04（0.12-0.4） mg/m L in the fornix-based conjunctival flap group（68 patients） and 0.28±0.04（0.20-0.33） mg/m L in the limbal-based conjunctival flap group（11 patients）. After bleb leakage, the patients＇ vision remained stable while the IOP decreased from 10.25±4.76（3-20.86） to 9.44±4.33（2-21） mm Hg（P〈0.01）. In the 41 analysed patients, the IOP was controlled at 15.68±5.11（7-40） mm Hg in the 1^（st） year after autologous conjunctival flap surgery and recurrence was not observed, for a long-term success rate of 100%. CONCLUSION： Autologous conjunctival flap repairing surgery is an effective technique for sealing filtering bleb leakages and controlling IOP postoperatively.展开更多
Purpose:Efficacy and long-term success of trabeculectomy largely depends on the postoperative development of a functioning filtering bleb.This study was designed to observe histological changes in filtering blebs afte...Purpose:Efficacy and long-term success of trabeculectomy largely depends on the postoperative development of a functioning filtering bleb.This study was designed to observe histological changes in filtering blebs after trabeculectomy using in vivo confocal microscopy (IVCM),and to investigate the correlation between morphologic appearance and function of filtering blebs.Methods:A total of 46 glaucoma patients who had received a trabeculectomy unilaterally in the past 1 to 60 months underwent slit-lamp examination,.applanation tonometry,and in vivo confocal microscopy.Eyes were classified into 4 groups according to the morphologic appearance of the filtering bleb based on the Kronfled system:type I blebs (8 eyes),type II blebs (14 eyes),type III blebs (16 eyes),and type IV blebs (8 eyes).The IVCM images were analyzed for the number of intraepithelial microcysts,the density of subepithelial connective tissue and the presence of blood vessels.Results:.Type II blebs presented with numerous intraepithelial vacuolar microcysts,while several large intraepithelial microcysts were found in type I blebs.Subepithelial connective tissue was widely spaced in type I and II blebs.In contrast,type Ⅲ and Ⅳ blebs showed few or no intraepithelial microcysts,and subepithelial connective tissue was densely distributed.Neovascularization was seen in 83.3% of failed blebs,whereas neovascularization was found in only 16.6% of successful blebs.Conclusion:.Different types of blebs reveal various histological characteristics at the cellular level,which appear to be correlated with postoperative filtering function.展开更多
基金Supported by the Science and Technology Project of Education Department of Jilin Province,No.JJKH20201089KJ.
文摘BACKGROUND Overhanging filtering bleb is a common complication after trabeculectomy and surgical repair is an effective treatment when the patient presents with apparent symptoms.Filtering bleb relevant infection including in the filtering bleb itself and even endophthalmitis in some severe cases has been reported.However,corneal fungal infection after filtering bleb repair is rarely reported.CASE SUMMARY A 57-year-old Chinese man who had sensations of redness and foreign body sensations in the left eye 3 wk after repair of overhanging filtering bleb.3 wk ago,due to sensations of a foreign body in the left eye for 3 years with worsening for 3 mo.The patient was diagnosed as overhanging filtering bleb and underwent a repair of overhanging filtering bleb.Postoperative,the filtering bleb formed well and the intraocular pressure is normal.But the patient gradually develop redness,pain and a grey infiltrate of the cornea in the eye.Finally it developed into fungal corneal ulcer.Through asking the medical history,we found the patient had irregularly self-medicated for years with glucocorticoid eye drops for years to relieve the foreign body sensation in the eye caused by filtering bleb overhanging.Because the glucocorticoid eye drops he used years ago had provide normal sensation to the eye.After 3 mo of anti-fungal treatment,the inflammation was controlled.CONCLUSION In addition to avoiding the development of overhanging filtering bleb after trabeculectomy,the present case report also suggests that clinicians should pay more attention to the patient’s ocular self-medication history.Particularly in patients with a history of glaucoma or eye surgery.Because these patients may be exposed to more types of eye drops than other individuals,they may select the wrong medi-cations for long-term use,based on their previous experience.
文摘BACKGROUND The major reason for filtering bleb failure or scarring of the bleb site is due to excessive scarring after glaucoma filtration surgery in the clinic.Traditional Chinese medicine has preeminence in the prevention of fibrosis formation through the regulation of systemic circulation and improvement of the properties of the inflammatory cells in the blood.AIM To examine the clinical efficacy of using the Modified Cortex Mori Capsules(MCMC;Chinese name:Jiawei Sangbaipi Capsules)in the success rate of functional filtering blebs after glaucoma filtering surgery in clinical patients.METHODS Sixty resurgery glaucoma patients were randomly divided into two groups:30 patients in surgery with the placebo group and 30 patients in surgery with the MCMC group.Patients took either the placebo or the MCMC 2 wk before and after surgery.Postoperative morphology and function filtering bleb,visual acuity,intraocular pressure,postoperative complications,the success rate of filtration surgery and clinical efficacy were observed.RESULTS Fifty patients completed the study.The percentage of functional filtering blebs in the surgery plus MCMC group was 84%at 6 mo after surgery,which was higher than surgery plus placebo group(64%,P<0.05).The surgical success rate in the MCMC and placebo groups were 79%±8.3%and 57%±10.6%respectively(P<0.05).The visual acuity,intraocular pressure and the postoperative complications in the two groups had no significant differences.CONCLUSION Glaucoma filtering surgery while taking MCMC not only reduced excessive scar formation and increased the success rate of functional filtering blebs but also improved the success of glaucoma filtration operations.
文摘AIM： To study the role of ultrasound biomicroscopy（UBM） in the assessment of the bleb function after trabeculectomy with mitomycin C（MMC）. METHODS： This was a cross-sectional study including all cases had undergone trabeculectomy with MMC 0.2 mg/mL for 3 min. Participants were recruited from the follow-up cases at Department of Ophthalmology, Tanta University in the period from August 2015 to August 2016. Full history taking and ophthalmological examination were performed. Intraocular pressure（IOP） was measured using Goldmann applanation tonometry and the history of prescribed postoperative antiglaucoma medications was recorded. Accordingly, the trabeculectomy blebs were divided clinically into successful blebs when the IOP post-operative was ≤18 mmHg without medications. Scanning examination of the filtering bleb using UBM examination was performed at the period from 2 to 36 mo after trabeculectomy（13.6±9.7 m o）. RESULTS： This study included 33 trabeculectomy filtering blebs of 25 patients（9 males and 16 females）. The mean age of patients was 53.2±14.2 y（range 25-71y）. We had 20 eyes with complete success, 9 eyes with qualified success, and 4 eyes with failure after trabeculectomy with MMC. The blebs were classified into successful blebs（IOP ≤18 mmHg without antiglaucoma medications）, others were classified into qualified successful and failed blebs. There was a significant correlation between certain UBM findings（intra-bleb reflectivity, draining sub-scleral tract, bleb height, and intrableb fluid cysts） and cases with different grades of clinical functional success（P〈0.01）.CONCLUSION： UBM is an objective tool in the functional assessment of the post-trabeculectomy filtering bleb through a significant correlation between certain UBM parameters and the different grades of clinical functional success.
基金Supported by the Guangdong Province Science and Technology Projects(No.2014A020212712)Guangzhou City Science and Technology Projects(No.2014Y2-00172)
文摘AIM： To evaluate the effectiveness of autologous conjunctival flap surgery for repairing the late-onset filtering bleb leakage after trabeculectomy.METHODS： This study retrospectively reviewed 106 eyes from 106 patients with late-onset filtering bleb leakage after trabeculectomy who received autologous conjunctival flap surgery at the Zhongshan Ophthalmic Centre from 2005 to 2015. The basic information was recorded, and the interval time between trabeculectomy and autologous conjunctival flap surgery as well as related risk factors, intraocular pressure（IOP）, anterior chamber depth（ACD） and best corrected visual acuity（BCVA） were analysed. Moreover, 41 patients who completed the 1-year follow up were analysed to determine the IOP and BCVA changes and long-term success rates.RESULTS： The 50 male and 56 female subjects（average age 39.13±17.96 y） included 47（44.34%） and 33（31.13%） cases of primary open angle and primary angle-closure glaucoma. The mean interval between trabeculectomy and repair surgery was 60.60±56.92（3-264）mo. The mean mitomycin（MMC） concentration during trabeculectomy was 0.27±0.04（0.12-0.4） mg/m L in the fornix-based conjunctival flap group（68 patients） and 0.28±0.04（0.20-0.33） mg/m L in the limbal-based conjunctival flap group（11 patients）. After bleb leakage, the patients＇ vision remained stable while the IOP decreased from 10.25±4.76（3-20.86） to 9.44±4.33（2-21） mm Hg（P〈0.01）. In the 41 analysed patients, the IOP was controlled at 15.68±5.11（7-40） mm Hg in the 1^（st） year after autologous conjunctival flap surgery and recurrence was not observed, for a long-term success rate of 100%. CONCLUSION： Autologous conjunctival flap repairing surgery is an effective technique for sealing filtering bleb leakages and controlling IOP postoperatively.
文摘Purpose:Efficacy and long-term success of trabeculectomy largely depends on the postoperative development of a functioning filtering bleb.This study was designed to observe histological changes in filtering blebs after trabeculectomy using in vivo confocal microscopy (IVCM),and to investigate the correlation between morphologic appearance and function of filtering blebs.Methods:A total of 46 glaucoma patients who had received a trabeculectomy unilaterally in the past 1 to 60 months underwent slit-lamp examination,.applanation tonometry,and in vivo confocal microscopy.Eyes were classified into 4 groups according to the morphologic appearance of the filtering bleb based on the Kronfled system:type I blebs (8 eyes),type II blebs (14 eyes),type III blebs (16 eyes),and type IV blebs (8 eyes).The IVCM images were analyzed for the number of intraepithelial microcysts,the density of subepithelial connective tissue and the presence of blood vessels.Results:.Type II blebs presented with numerous intraepithelial vacuolar microcysts,while several large intraepithelial microcysts were found in type I blebs.Subepithelial connective tissue was widely spaced in type I and II blebs.In contrast,type Ⅲ and Ⅳ blebs showed few or no intraepithelial microcysts,and subepithelial connective tissue was densely distributed.Neovascularization was seen in 83.3% of failed blebs,whereas neovascularization was found in only 16.6% of successful blebs.Conclusion:.Different types of blebs reveal various histological characteristics at the cellular level,which appear to be correlated with postoperative filtering function.
